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Year 2013, Volume: 35 Issue: 1, 66 - 75, 22.03.2013

Abstract

Aim. Our aim was to investigate the clinicopathological features, the treatment outcome and the prognostic factors affecting survival in patients with head and neck cancer followed and treated in our center. Methods. The demographic, clinical and the histopathological data of the patients who were admitted to our center between 2007 and 2010 with a diagnosis of head and neck cancer were examined using the medical records. Results. The data from 82 patients were analyzed. There were 72 men (88%) and 10 women (12%). The median age of the patients was 57 (20-80) years. The youngest patients had nasopharyngeal, parahypopharyngeal and paranasal sinus tumors. The most commonly encountered malignancy was the laryngeal cancer, which was found in 37 patients (45%). Fifty-five patients (67%) were Eastern Cooperative Oncology Group 1. The most common grade was the locally advanced stage with 51 patients (62%). At time of the diagnosis, 60 (75%) patients had anemia, 30 (60%) patients had an elevated C-reactive protein, and 72 (89%) patients had weight loss. Squamous cell carcinoma, which was seen in 69 (84%) patients, was the most common histological type. Seventeen (47%) patients had perineural invasion, 17 (47%) patients had lymphovascular invasion, and 12 (32%) patients had extracapsular invasion. Among the patients, the most common grade was grade II, which was found in 34 (42%) patients. The overall median survival was 34 months. The 2-year survival rate was 75% for the patients with early-stage (I-II) cancer and 51% for the patients with locally advanced (III-IVA and B) cancer, the median survival was 10 months in the presence of metastatic disease. The presence of hypertension comorbidity, performance status, location and stage of the cancer, T and N stage, interruption of radiation therapy, C-reactive protein levels, and anemia were the factors that determined survival. Conclusion. The presence of hypertension, performance status, location and stage of the cancer, T and N stage, interruption of radiation therapy, C-reactive protein levels, and anemia were identified as prognostic factors affecting survival in patients with head and neck cancers.

References

  • Jemal A, Murray T, Samuels A, Ghafoor A, Ward E, Thun MJ. Cancer Statistics, 200 CA Cancer J Clin 2003; 53: 5-26.
  • Öztop İ. Baş-boyun tümörlerinde hedefe yönelik tedavi. Uluslararası HematolojiOnkoloji Dergisi 2008; 1: 46-56.
  • Kamangar F, Dores GM, Anderson WF. Patterns of cancer incidence, mortality, and prevalence across five continents: defining priorities to reduce cancer disparities in different geographic regions of the world. J Clin Oncol 2006; 24: 2137Aydıner A, Topuz E. Onkoloji El Kitabı. In: Uslu R, Bilgen C, Esassolak M. Baş ve boyun kanserleri. 1. baskı. İstanbul: Turgut Yayıncılık 2006; pp: 81-115.
  • Harrison, Louis B, Roy B, Houng, Waun KI. Head and Neck Cancer: A Multidisciplinary Approach. In: Smith BD, Haffty BG. Prognostic Factors in Patients with Head and Neck Cancer. 3rd edition. Philadelphia: Lippincott Williams & Wilkins 2009; pp: 52-70.
  • Greene FL, Page DL, Fleming ID, Fritz A, Balch CM, Haller DG, Morrow M. AJCC Cancer Staging Handbook. In: TNM classification of malignant tumours. 6th ed. New York:Springer-Verlag; 2002
  • National Cancer Institute. Cancer Therapy Evaluation Program Common Toxicity Criteria Manuel, Version 2.0 Piccirillo JF, Tierney RM, Costas I, Grove L, Spitznagel EL Jr. Prognostic importance of comorbidity in a hospital-based cancer registry. JAMA 2004; 291: 2441Reid BC, Alberg AJ, Klassen AC, Samet JM, Rozier RG, Garcia I, Winn DM. Comorbidity and survival of elderly head and neck carcinoma patients. Cancer 2001; 92: 2109-16.
  • Rades D, Fehlauer F, Wroblesky J, Albers D, Schild SE, Schmidt R. Prognostic factors in head-and-neck cancer patients treated with surgery followed by intensity-modulated radiotherapy (IMRT), 3D-conformal radiotherapy, or conventional radiotherapy. Oral Oncol 2007; 43: 535-43.
  • Abraham J, Allegra CJ, Gulley J. Klinik Onkolji El Kitabı. In: Conley BA, Forastiere AA, Gius D, VanWaes C. Baş Boyun. Çeviri Editörü Alpaslan Mayadağlı, Cem Parlak.1.baskı. İstanbul: Nobel Tıp Kitabevi 2009; s: 3-31.
  • Prosnitz RG, Yao B, Farrell CL, Clough R, Brizel DM. Pretreatment anemia is correlated with the reduced effectiveness of radiation and concurrent chemotherapy in advanced head and neck cancer. Int J Radiat Oncol Biol Phys 2005; 61: 1087-95.
  • Brizel DM, Albers ME, Fisher SR, Scher RL, Richtsmeier WJ, Hars V, George SL, Huang AT, Prosnitz LR. Hyperfractionated irradiation with or without concurrent chemotherapy for locally advanced head and neck cancer. N Engl J Med 1998; 338: 1798-804.
  • Rahima B, Shingaki S, Nagata M, Saito C. Prognostic significance of perineural invasion in oral and oropharyngeal carcinoma. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2004; 97: 423-31.
  • Yılmaz T, Hosal AS, Gedikoğlu G, Önerci M, Gürsel B. Prognostic significance of vascular and perineural invasion in cancer of the larynx. Am J Otolaryngol 1998; 19: 83-8.
  • Nicolai P, Redaelli de Zinis LO, Tomenzoli D, Barezzani MG, Bertoni F, Bignardi M, Antonelli AR. Prognostic determinants in supraglottic carcinoma: univariate and Cox regression analysis. Head Neck 1997; 19: 323-34.
  • Khandavilli SD, Ceallaigh PO, Lloyd CJ, Whitaker R. Serum C-reactive protein as a prognostic indicator in patients with oral squamous cell carcinoma. Oral Oncol 2009; 45: 912-4.
  • Fowler JF, Lindstrom MJ. Loss of local control with prolongation in radiotherapy. Int J Radiat Oncol Biol Phys 1992; 23: 457-67.
  • Meydan D, Gürsel B, Şahin N, Özbek N. Erken evre glottik larenks kanserinde radyoterapi sonuçları: Tek merkez deneyimi. Deneysel ve Klinik Tıp Dergisi 2012; 29: 141-7.
  • Staar S, Rudat V, Stuetzer H, Dietz A, Volling P, Schroeder M, Flentje M, Eckel HE, Mueller RP. Intensified hyperfractionated accelerated radiotherapy limits the additional benefit of simultaneous chemotherapy--results of a multicentric randomized German trial in advanced head-and-neck cancer. Int J Radiat Oncol Biol Phys 2001; 50: 1161-71.
  • Akman F. Yerel ileri baş-boyun kanserlerinde kemoradyoterapi. Turkiye Klinikleri J Med Oncol-Special Topics 2010; 3: 36-40.
  • Lee AW, Lau WH, Tung SY, Chua DT, Chappell R, Xu L, Siu L, Sze WM, Leung TW, Sham JS, Ngan RK, Law SC, Yau TK, Au JS, O'Sullivan B, Pang ES, O SK, Au GK, Lau JT; Hong Kong Nasopharyngeal Cancer Study Group. Preliminary results of a randomized study on therapeutic gain by concurrent chemotherapy for regionally-advanced nasopharyngeal carcinoma: NPC-9901 Trial by the Hong Kong Nasopharyngeal Cancer Study Group. J Clin Oncol 2005; 23: 6966-75.
  • Chan AT, Teo PM, Ngan RK, Leung TW, Lau WH, Zee B, Leung SF, Cheung FY, Yeo W, Yiu HH, Yu KH, Chiu KW, Chan DT, Mok T, Yuen KT, Mo F, Lai M, Kwan WH, Choi P, Johnson PJ. Concurrent chemotherapy-radiotherapy compared with radiotherapy alone in locoregionally advanced nasopharyngeal carcinoma: progression-free survival analysis of a phase III randomized trial. J Clin Oncol 2002; 20: 2038-44.
  • Wee J, Tan EH, Tai BC, Wong HB, Leong SS, Tan T, Chua ET, Yang E, Lee KM, Fong KW, Tan HS, Lee KS, Loong S, Sethi V, Chua EJ, Machin D. Randomized trial of radiotherapy versus concurrent chemoradiotherapy followed by adjuvant chemotherapy in patients with American Joint Committee on Cancer/International Union against cancer stage III and IV nasopharyngeal cancer of the endemic variety. J Clin Oncol 2005; 23: 6730-8.
  • Cheng SH, Tsai SY, Yen KL, Jian JJ, Chu NM, Chan KY, Tan TD, Cheng JC, Hsieh CY, Huang AT. Concomitant radiotherapy and chemotherapy for earlystage nasopharyngeal carcinoma. J Clin Oncol 2000; 18: 2040-5.
  • Machtay M, Rosenthal DI, Hershock D, Jones H, Williamson S, Greenberg MJ, Weinstein GS, Aviles VM, Chalian AA, Weber RS; Penn Cancer Center Clinical Trials Group. Organ preservation therapy using induction plus concurrent chemoradiation for advanced resectable oropharyngeal carcinoma: A University of Pennsylvania Phase II Trial. J Clin Oncol 2002; 20: 3964-71.
  • Adelstein DJ, Saxton JP, Lavertu P, Rybicki LA, Esclamado RM, Wood BG, Strome M, Carroll MA. Maximizing local control and organ preservation in stage IV squamous cell head and neck cancer With hyperfractionated radiation and concurrent chemotherapy. J Clin Oncol 2002; 20:1405-10.
  • Cooper JS, Pajak TF, Forastiere AA, Jacobs J, Campbell BH, Saxman SB, Kish JA, Kim HE, Cmelak AJ, Rotman M, Machtay M, Ensley JF, Chao KS, Schultz CJ, Lee N, Fu KK; Radiation Therapy Oncology Group 9501/Intergroup. Postoperative concurrent radiotherapy and chemotherapy for high-risk squamouscell carcinoma of the head and neck. N Engl J Med 2004; 350: 1937-44.
  • Bernier J, Domenge C, Ozsahin M, Matuszewska K, Lefèbvre JL, Greiner RH, Giralt J, Maingon P, Rolland F, Bolla M, Cognetti F, Bourhis J, Kirkpatrick A, van Glabbeke M; European Organization for Research and Treatment of Cancer Trial 22931. Postoperative irradiation with or without concomitant chemotherapy for locally advanced head and neck cancer. N Engl J Med 2004; 350: 1945-52.
  • Bonner JA, Harari PM, Giralt J, Azarnia N, Shin DM, Cohen RB, Jones CU, Sur R, Raben D, Jassem J, Ove R, Kies MS, Baselga J, Youssoufian H, Amellal N, Rowinsky EK, Ang KK. Radiotherapy plus cetuximab for squamous-cell carcinoma of the head and neck. N Engl J Med 2006; 354: 567-78.

Baş boyun kanserli hastalarda tedavi sonuçları ve prognostik faktörler

Year 2013, Volume: 35 Issue: 1, 66 - 75, 22.03.2013

Abstract

Özet

Amaç. Merkezimizde takip ve tedavi edilen baş boyun kanseri hastalarında klinikopatolojik özelliklerin, tedavi sonuçlarının ve sağkalımı etkileyen prognostik faktörlerin incelenmesi amaçlanmıştır. Yöntem. 2007-2010 tarihleri arasında merkezimize başvuran ve baş boyun kanseri tanısı ile izlenmekte olan hastalara ait demografik, klinik ve histopatolojik veriler hasta dosya ve hastane kayıtları incelenerek elde edildi. Bulgular. Seksen iki hastaya ait veriler analiz edildi. 72 erkek (%88) ve 10 kadın (%12) hasta mevcuttu. Hastaların ortanca yaşı 57 (20-80) idi. En genç hastalar nazofarenks, parahipofarenks ve paranazal sinüs tümörü olan hastalardı. En yaygın malignensi 37 hastada (%45) bulunan larenks kanseri idi. Elli beş hasta (%67) Eastern Cooperative Oncology Group 1 idi. En sık evre 51 hasta (%62) ile lokal ileri evre idi. Tanı anında 60 (%75) hastada anemi, 30 (%60) hastada C- reaktif protein yüksekliği, 72 (%89) hastada kilo kaybı tespit edildi. Yassı hücreli karsinom 69 (%84) hasta  ile en sık izlenen histopatolojik tip idi. On yedi (%47) hastada perinöral invazyon, 17 (%47) hastada lenfovasküler invazyon, 12 (%32) hastada ekstrakapsüler invazyon tespit edildi. Hastalar arasında en sık izlenen grade 34 (%42) hasta ile grade II idi. Tüm hastalar için ortanca sağkalım 34 aydı. İki yıllık genel sağkalım oranı erken evre (I-II) hastalarda %75, lokal ileri hastalarda (III-IVA ve B) %51 iken, metastatik hastalık varlığında ise ortanca sağkalım 10 ay idi. Eşlik eden hipertansiyon varlığı, performans durumu, kanserin lokalizasyonu ve evresi, T ve N evresi, radyoterapiye ara verilmesi, C- reaktif protein düzeyi ve anemi sağkalımı belirleyen faktörler idi. Sonuç. Hipertansiyon varlığı, performans durumu, kanserin lokalizasyon ve evresi, T ve N evresi, radyoterapiye ara verilmesi, C- reaktif protein düzeyi ve anemi baş boyun kanserli hastalarda sağkalımı etkileyen prognostik faktörler olarak belirlendi.

Anahtar sözcükler: Baş boyun kanseri, radyoterapi, kemoterapi, prognoz

 

Abstract

Aim. Our aim was to investigate the clinicopathological features, the treatment outcome and the prognostic factors affecting survival in patients with head and neck cancer followed and treated in our center. Methods. The demographic, clinical and the histopathological data of the patients who were admitted to our center between 2007 and 2010 with a diagnosis of head and neck cancer were examined using the medical records. Results. The data from 82 patients were analyzed. There were 72 men (88%) and 10 women (12%). The median age of the patients was 57 (20-80) years. The youngest patients had nasopharyngeal, parahypopharyngeal and paranasal sinus tumors. The most commonly encountered malignancy was the laryngeal cancer, which was found in 37 patients (45%). Fifty-five patients (67%) were Eastern Cooperative Oncology Group 1. The most common grade was the locally advanced stage with 51 patients (62%). At time of the diagnosis, 60 (75%) patients had anemia, 30 (60%) patients had an elevated C-reactive protein, and 72 (89%) patients had weight loss. Squamous cell carcinoma, which was seen in 69 (84%) patients, was the most common histological type. Seventeen (47%) patients had perineural invasion, 17 (47%) patients had lymphovascular invasion, and 12 (32%) patients had extracapsular invasion. Among the patients, the most common grade was grade II, which was found in 34 (42%) patients. The overall median survival was 34 months. The 2-year survival rate was 75% for the patients with early-stage (I-II) cancer and 51% for the patients with locally advanced (III-IVA and B) cancer, the median survival was 10 months in the presence of metastatic disease. The presence of hypertension comorbidity, performance status, location and stage of the cancer, T and N stage, interruption of radiation therapy, C-reactive protein levels, and anemia were the factors that determined survival. Conclusion. The presence of hypertension, performance status, location and stage of the cancer, T and N stage, interruption of radiation therapy, C-reactive protein levels, and anemia were identified as prognostic factors affecting survival in patients with head and neck cancers.

Keywords: Head and neck cancer, radiotherapy, chemotherapy, prognosis

References

  • Jemal A, Murray T, Samuels A, Ghafoor A, Ward E, Thun MJ. Cancer Statistics, 200 CA Cancer J Clin 2003; 53: 5-26.
  • Öztop İ. Baş-boyun tümörlerinde hedefe yönelik tedavi. Uluslararası HematolojiOnkoloji Dergisi 2008; 1: 46-56.
  • Kamangar F, Dores GM, Anderson WF. Patterns of cancer incidence, mortality, and prevalence across five continents: defining priorities to reduce cancer disparities in different geographic regions of the world. J Clin Oncol 2006; 24: 2137Aydıner A, Topuz E. Onkoloji El Kitabı. In: Uslu R, Bilgen C, Esassolak M. Baş ve boyun kanserleri. 1. baskı. İstanbul: Turgut Yayıncılık 2006; pp: 81-115.
  • Harrison, Louis B, Roy B, Houng, Waun KI. Head and Neck Cancer: A Multidisciplinary Approach. In: Smith BD, Haffty BG. Prognostic Factors in Patients with Head and Neck Cancer. 3rd edition. Philadelphia: Lippincott Williams & Wilkins 2009; pp: 52-70.
  • Greene FL, Page DL, Fleming ID, Fritz A, Balch CM, Haller DG, Morrow M. AJCC Cancer Staging Handbook. In: TNM classification of malignant tumours. 6th ed. New York:Springer-Verlag; 2002
  • National Cancer Institute. Cancer Therapy Evaluation Program Common Toxicity Criteria Manuel, Version 2.0 Piccirillo JF, Tierney RM, Costas I, Grove L, Spitznagel EL Jr. Prognostic importance of comorbidity in a hospital-based cancer registry. JAMA 2004; 291: 2441Reid BC, Alberg AJ, Klassen AC, Samet JM, Rozier RG, Garcia I, Winn DM. Comorbidity and survival of elderly head and neck carcinoma patients. Cancer 2001; 92: 2109-16.
  • Rades D, Fehlauer F, Wroblesky J, Albers D, Schild SE, Schmidt R. Prognostic factors in head-and-neck cancer patients treated with surgery followed by intensity-modulated radiotherapy (IMRT), 3D-conformal radiotherapy, or conventional radiotherapy. Oral Oncol 2007; 43: 535-43.
  • Abraham J, Allegra CJ, Gulley J. Klinik Onkolji El Kitabı. In: Conley BA, Forastiere AA, Gius D, VanWaes C. Baş Boyun. Çeviri Editörü Alpaslan Mayadağlı, Cem Parlak.1.baskı. İstanbul: Nobel Tıp Kitabevi 2009; s: 3-31.
  • Prosnitz RG, Yao B, Farrell CL, Clough R, Brizel DM. Pretreatment anemia is correlated with the reduced effectiveness of radiation and concurrent chemotherapy in advanced head and neck cancer. Int J Radiat Oncol Biol Phys 2005; 61: 1087-95.
  • Brizel DM, Albers ME, Fisher SR, Scher RL, Richtsmeier WJ, Hars V, George SL, Huang AT, Prosnitz LR. Hyperfractionated irradiation with or without concurrent chemotherapy for locally advanced head and neck cancer. N Engl J Med 1998; 338: 1798-804.
  • Rahima B, Shingaki S, Nagata M, Saito C. Prognostic significance of perineural invasion in oral and oropharyngeal carcinoma. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2004; 97: 423-31.
  • Yılmaz T, Hosal AS, Gedikoğlu G, Önerci M, Gürsel B. Prognostic significance of vascular and perineural invasion in cancer of the larynx. Am J Otolaryngol 1998; 19: 83-8.
  • Nicolai P, Redaelli de Zinis LO, Tomenzoli D, Barezzani MG, Bertoni F, Bignardi M, Antonelli AR. Prognostic determinants in supraglottic carcinoma: univariate and Cox regression analysis. Head Neck 1997; 19: 323-34.
  • Khandavilli SD, Ceallaigh PO, Lloyd CJ, Whitaker R. Serum C-reactive protein as a prognostic indicator in patients with oral squamous cell carcinoma. Oral Oncol 2009; 45: 912-4.
  • Fowler JF, Lindstrom MJ. Loss of local control with prolongation in radiotherapy. Int J Radiat Oncol Biol Phys 1992; 23: 457-67.
  • Meydan D, Gürsel B, Şahin N, Özbek N. Erken evre glottik larenks kanserinde radyoterapi sonuçları: Tek merkez deneyimi. Deneysel ve Klinik Tıp Dergisi 2012; 29: 141-7.
  • Staar S, Rudat V, Stuetzer H, Dietz A, Volling P, Schroeder M, Flentje M, Eckel HE, Mueller RP. Intensified hyperfractionated accelerated radiotherapy limits the additional benefit of simultaneous chemotherapy--results of a multicentric randomized German trial in advanced head-and-neck cancer. Int J Radiat Oncol Biol Phys 2001; 50: 1161-71.
  • Akman F. Yerel ileri baş-boyun kanserlerinde kemoradyoterapi. Turkiye Klinikleri J Med Oncol-Special Topics 2010; 3: 36-40.
  • Lee AW, Lau WH, Tung SY, Chua DT, Chappell R, Xu L, Siu L, Sze WM, Leung TW, Sham JS, Ngan RK, Law SC, Yau TK, Au JS, O'Sullivan B, Pang ES, O SK, Au GK, Lau JT; Hong Kong Nasopharyngeal Cancer Study Group. Preliminary results of a randomized study on therapeutic gain by concurrent chemotherapy for regionally-advanced nasopharyngeal carcinoma: NPC-9901 Trial by the Hong Kong Nasopharyngeal Cancer Study Group. J Clin Oncol 2005; 23: 6966-75.
  • Chan AT, Teo PM, Ngan RK, Leung TW, Lau WH, Zee B, Leung SF, Cheung FY, Yeo W, Yiu HH, Yu KH, Chiu KW, Chan DT, Mok T, Yuen KT, Mo F, Lai M, Kwan WH, Choi P, Johnson PJ. Concurrent chemotherapy-radiotherapy compared with radiotherapy alone in locoregionally advanced nasopharyngeal carcinoma: progression-free survival analysis of a phase III randomized trial. J Clin Oncol 2002; 20: 2038-44.
  • Wee J, Tan EH, Tai BC, Wong HB, Leong SS, Tan T, Chua ET, Yang E, Lee KM, Fong KW, Tan HS, Lee KS, Loong S, Sethi V, Chua EJ, Machin D. Randomized trial of radiotherapy versus concurrent chemoradiotherapy followed by adjuvant chemotherapy in patients with American Joint Committee on Cancer/International Union against cancer stage III and IV nasopharyngeal cancer of the endemic variety. J Clin Oncol 2005; 23: 6730-8.
  • Cheng SH, Tsai SY, Yen KL, Jian JJ, Chu NM, Chan KY, Tan TD, Cheng JC, Hsieh CY, Huang AT. Concomitant radiotherapy and chemotherapy for earlystage nasopharyngeal carcinoma. J Clin Oncol 2000; 18: 2040-5.
  • Machtay M, Rosenthal DI, Hershock D, Jones H, Williamson S, Greenberg MJ, Weinstein GS, Aviles VM, Chalian AA, Weber RS; Penn Cancer Center Clinical Trials Group. Organ preservation therapy using induction plus concurrent chemoradiation for advanced resectable oropharyngeal carcinoma: A University of Pennsylvania Phase II Trial. J Clin Oncol 2002; 20: 3964-71.
  • Adelstein DJ, Saxton JP, Lavertu P, Rybicki LA, Esclamado RM, Wood BG, Strome M, Carroll MA. Maximizing local control and organ preservation in stage IV squamous cell head and neck cancer With hyperfractionated radiation and concurrent chemotherapy. J Clin Oncol 2002; 20:1405-10.
  • Cooper JS, Pajak TF, Forastiere AA, Jacobs J, Campbell BH, Saxman SB, Kish JA, Kim HE, Cmelak AJ, Rotman M, Machtay M, Ensley JF, Chao KS, Schultz CJ, Lee N, Fu KK; Radiation Therapy Oncology Group 9501/Intergroup. Postoperative concurrent radiotherapy and chemotherapy for high-risk squamouscell carcinoma of the head and neck. N Engl J Med 2004; 350: 1937-44.
  • Bernier J, Domenge C, Ozsahin M, Matuszewska K, Lefèbvre JL, Greiner RH, Giralt J, Maingon P, Rolland F, Bolla M, Cognetti F, Bourhis J, Kirkpatrick A, van Glabbeke M; European Organization for Research and Treatment of Cancer Trial 22931. Postoperative irradiation with or without concomitant chemotherapy for locally advanced head and neck cancer. N Engl J Med 2004; 350: 1945-52.
  • Bonner JA, Harari PM, Giralt J, Azarnia N, Shin DM, Cohen RB, Jones CU, Sur R, Raben D, Jassem J, Ove R, Kies MS, Baselga J, Youssoufian H, Amellal N, Rowinsky EK, Ang KK. Radiotherapy plus cetuximab for squamous-cell carcinoma of the head and neck. N Engl J Med 2006; 354: 567-78.
There are 27 citations in total.

Details

Primary Language Turkish
Journal Section Medical Science Research Articles
Authors

Ebru Atasever Akkaş

Birsen Yücel

Saadettin Kılıçkap

Nalan Akgül Babacan

Emine Altuntaş

Publication Date March 22, 2013
Published in Issue Year 2013Volume: 35 Issue: 1

Cite

AMA Atasever Akkaş E, Yücel B, Kılıçkap S, Akgül Babacan N, Altuntaş E. Baş boyun kanserli hastalarda tedavi sonuçları ve prognostik faktörler. CMJ. March 2013;35(1):66-75.